Implementation of a Comprehensive Protocol for Enhanced Recovery After Surgery (ERAS) in Kidney Transplant Recipients Improves Patient and Graft Outcomes

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols have gained widespread acceptance as a means to enhance surgical outcomes. However, the intricate care required for kidney transplant recipients has not yet led to the establishment of a universally recognized and dependable ERAS protocol for kidney transplantation.

Objective: We devised a customized ERAS protocol to determine its effectiveness in improving surgical and postoperative outcomes among kidney transplant recipients.

Design, setting, and participants: This was a retrospective, single-center study performed at our tertiary care institution. Three hundred and fifty-six patients in the conventional group (from January 1, 2015 to December 31, 2017) and 442 patients from the ERAS group (from January 1, 2018 to June 1, 2020) were compared. Patients were followed for 1 year postoperatively.

Intervention: Changes were made in the preoperative, operative, postoperative, and outpatient follow-up settings after transplantation.

Outcome measurements and statistical analysis: Primary endpoints were hospital length of stay (LOS) and 30-day readmission rates. We also measured surgical outcomes, graft performance, and patient survival. Wilcoxon rank-sum, Pearson's Chi-squared, or Fisher's exact tests were used to compare groups.

Results: Our ERAS protocol was associated with a decrease in hospital LOS from 5 to 3 days (p < 0.001) and 57.1% lower odds of hospital readmissions within 30 days compared to the conventional group (p < 0.001, 95% CI 0.26-0.7). Decreases in operative estimated blood loss, blood transfusion rates, and delayed graft function were also associated with the ERAS protocol.

Conclusion: Our multi-layered ERAS protocol is effective in improving outcomes for kidney transplant recipients. A future multi-institutional study with healthcare savings analysis may suggest that widespread benefits are yet to be realized by the greater implementation of such enhanced recovery protocols.

Keywords: ERAS; enhanced recovery after surgery; graft outcomes; kidney transplant; patient outcomes; renal disease; renal transplant.